AIDS came to Russia after it hit epidemic levels in other regions of the world. During the Soviet era, population movements were restricted but that changed in the early 1990s. Russia registered its first case of AIDS in 1987; by the end of the 20th century there were an estimated 20,000 cases, and some estimates suggest that the number of AIDS cases in Russia has doubled every year since 1998.

Recent international attention has been directed toward Russia's healthcare system, the stigma attached to those infected, and Russia's drug policies; the country's geographic location puts it between Central Asia, where heroin is produced, and Europe, where it's sold.

'Red Ribbon' symbol of solidarity of people living with HIV/AIDS. Image by Flickr user Andy McCarthy UK (CC BY-NC 2.0).

The New York office director of UNAIDS, Bertil Lindblad, is worried about the one region of the world where HIV infections are increasing, even as rates in the rest of the world level off. It's not in Africa or Asia, or even Latin America. It's Eastern Europe — countries like Russia and Ukraine — where a recent UNICEF report notes that increases in infection rates of as high as 700 percent have been seen since 2006.

“There is an urgent need for the whole Eastern European and Central Asian region to act quickly,” Lindblad said this morning. “This is really quite scary given the fact that there is denial, and so much stigma and homophobia [in that region.] This could really create huge problems if HIV continues to spread from smaller groups in the population to wider.”

The world is taking notice of the epidemic as evidenced by a Russian Embassy Protest Blog press release on December 5, 2011, pertaining to the World AIDS Day protests:

On World Aids Day, 2011, just a few short days ago, harm reduction organisations led by people who use drugs and supported by the International Network of People who Use Drugs (INPUD) gathered outside Russian embassies in cities across the world in the largest ever global show of solidarity by and for people who use drugs.

The protests, entitled ‘Shame Russia Shame’, was directed at Russia’s highly controversial drug policies which are believed to be driving the EEC regions HIV and TB epidemics. Injecting drugs with contaminated equipment is driving Russia’s HIV epidemic, now the fastest growing in the world and it is reflected in the numbers; as many as 80% of new infections are occurring amongst people who inject drugs (PWID), in a total HIV positive population of approx 1.3 million. With this in mind, recent projections forecast an additional 5 million people could become infected with HIV in the near future, unless Russia drastically transforms the way it is dealing with its HIV pandemic.

Masha Ovchinnikova posted a 2007 text for AIDS and Social Justice Blog entitled, “Harm Reduction Activism in Russia.” A former drug user living in Moscow, Ms. Ovchinnikova discussed the challenges drug users face in Russia when they seek treatment:

Many financial, bureaucratic and moral barriers keep drug users from being able to take care of their health, or sometimes their lives. People can’t receive any medical help at the usual clinics if they are “kicking.” If you want to go into a detox program, you have to wait a few weeks, sometimes more. You have to prepare a lot of documents and take some tests (including HIV testing). Then, there is no guarantee you’ll get good medicine — but what’s for sure is that you’ll be blamed and humiliated by the clinic staff.

Another problem is confidentiality of “drug user status.” You can’t get free treatment without official registration, but this list sometimes becomes available to the police. Although the situation has become somewhat better recently, the level of police abuse is still very high. Sometimes it’s still dangerous to buy a new syringe because the police are watching drug users near the pharmacies.

In my clinic, the psychiatrists work in rooms next to the medical doctors. Today in clinic, I spoke to Mark Sulkowski, infectious diseases doc specializing in HIV-hepatitis C coinfection. We have several patients together. I know I can knock on his door anytime he’s not with a patient to discuss a patient or the latest new drug for hepatitis C (we have two new protease inhibitors that will likely increase cure rates). We also have social workers and pharmacists and case managers and primary care docs and OB/GYNs and dermatologists and ophthalmologists and neurologists. And we all write in the same charts and manage the same patients together.

In Russia, no such system exists. Last week, we were discussing the tricky problem of managing patients with HIV infection, active tuberculosis, and active injection drug use. The biggest problem is there is no system. TB is treated in the TB clinic, HIV in the HIV clinic, and drugs in the “narcology” clinic (which is independent of both psychiatry and general medicine). And nobody talks to anybody else.

In a post entitled “AIDS in Russia – Why Russia is Particularly Vulnerable,” I discussed how Russian healthcare professionals are ill-equipped to treat those infected with HIV. Regional centers claim that they provide both pre- and post-test counseling, but that is not always the case, as illustrated by an account of a young woman in Nizhny Novgorod:

When I tested positive, I was completely shocked. I was told to go see a counselor. When I met the counselor, she said: ‘You are infected with HIV. Please be advised that knowingly spreading HIV is a criminal offense under Russian law. If you have unprotected sex and spread the virus, you will be incarcerated. Sign this document to show that you have understood.’ That was all the counseling I got. When I got in the hallway, I thought I would faint. I didn't know anything about ARV's [anti-retrovirals]. I found out about them only last year when I was in Moscow.

As in many countries, the attitude toward those infected with HIV/AIDS is a real issue. HIVnet.ru posted a music video intended to mitigate this stigma by showing how an attractive young couple coped with learning that they were HIV+. A popular Russian-language LJ blog discussed the issues [ru] surrounding the stigma:

In our society, there is a pattern in conduct directed towards people who are HIV+ in that they are effectively “buried alive.” Friends only contact those infected sparingly lest they too become infected. Any excuse would be used to expel [an infected person] from school and there's no way to find a new job. And the problem isn't even with the evil employers – you yourself would be the first ones to protest if a nanny at your kid's kindergarten is HIV-infected. […] Even doctors, who would seem to be knowledgeable people, deny people treatment if they recognize the patient has HIV.

But this is not the only problem – many people, fearing the stigma associated with infection, refuse to get diagnosed, and when they do learn their diagnosis, they conceal it, and this in turn leads to a rapid development of the epidemic. The only way to combat this is the re-education of society. […]

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